In hospital settings, specialists are often consulted when managing patients with complex conditions, offering evidence-based recommendations on diagnosis and treatment plans. Infectious disease (ID) specialists are typically consulted when patients have one or more infectious conditions that are severe and require intensive monitoring. “ID specialists can assist hospitals in the inpatient setting by recommending appropriate antibiotic choices, duration of therapy, and route of delivery,” says Steven K. Schmitt, MD. “They can also help monitor patients to minimize adverse drug reactions.”
Studies indicate that when an ID specialist is involved in patient care and the physician in charge follows ID recommendations, patients are more likely to receive a correct diagnosis. ID specialist involvement has also been associated with shorter lengths of stay (LOS), receipt of more appropriate therapies, fewer complications, and reduced use of antibiotics overall. However, data regarding the impact of ID specialists on hospital LOS and costs have been mixed. Many studies have been constrained by small sample size and chart review methodology, which limits the ability to generalize conclusions. As a result, it has been difficult to draw meaningful conclusions about the value of ID specialty interventions.
In a study published in Clinical Infectious Diseases, Dr. Schmitt and colleagues sought to generate robust data on the impact of ID consultation on spending and outcomes using a national Medicare claims database. Researchers looked at patients hospitalized with at least one of 11 serious but commonly treated infections. These included bacteremia, Clostridium difficile, central line-associated bloodstream infections, bacterial endocarditis, HIV/opportunistic infections, meningitis, osteomyelitis, prosthetic joint infections, septic arthritis, septic shock, and vascular device infections. Outcomes of a matched sample of 61,680 hospitalized patients with infection who saw an ID specialist were then compared with 65,192 hospitalized patients who did not see one of these specialists.
When compared with no ID involvement, the analysis revealed that patients treated by ID specialists were less likely to die in the hospital or after discharge and less likely to be readmitted to the hospital within 30 days (Table 1). Those seeing ID specialists had slightly longer LOS overall, but the ICU LOS was shorter. The study noted that Medicare charges and payments were not significantly different in this initial analysis.
The benefits of ID consultation were more pronounced when patients were seen earlier (Table 2). Patients seen by an ID physician within 2 days of being admitted to the hospital were less likely to be readmitted within 30 days of discharge when compared with patients seen by ID specialists after the first 2 days. These patients also spent fewer days in the hospital or ICU. The total Medicare costs for these patients were also lower in the 30 days after discharge from the hospital.
“With healthcare-acquired infections now being linked to payment penalties
and bundled payments, there is little room for error.”
“Using ID specialist consultations correlated with positive outcomes across many of the domains assessed in our study, which are metrics critical in the healthcare reform conversation,” says Dr. Schmitt. “Involving ID specialists as early as possible can further enhance outcomes.” He adds that the study was strengthened by the use of a large national dataset of Medicare patients with several types of common, severe infections, making the findings more generally applicable.
Taken as a whole, the study data from Dr. Schmitt and colleagues suggest that appropriate inpatient specialty care may generate value for the healthcare system. “The impact of ID specialist involvement can be seen in both quality and cost of care across a broad range of ID diagnoses,” he says. “Although we observed small absolute differences, the findings illustrate the significant effects that can be achieved by involving ID specialists in care.”
The rapidly evolving healthcare environment is increasingly influencing reimbursement and pay-ment to hospitals and physicians, meaning the value of their services must be demonstrated. “With healthcare-acquired infections now being linked to payment penalties and bundled payments, there is little room for error,” says Dr. Schmitt. “The impact of ID physicians is more critical than ever to providing high-quality care. Our data demonstrate that including ID specialists at the front line provides better outcomes and lower costs.”
The link between ID involvement and reduced readmission rates also suggests an important role for ID specialists in transitions of care. “More studies are needed to further measure and validate the effect of ID specialty involvement,” Dr. Schmitt says. “As
we gather this data and apply it to patient care, we may help guide how resources are allocated and develop a more complete view of the value of these moving parts.”
Readings & Resources (click to view)
Schmitt S, McQuillen DP, Nahass R, et al. Infectious diseases specialty intervention is associated with decreased mortality and lower healthcare costs. Clin Infect Dis. 2013 Sep 25 [Epub ahead of print]. Available at: http://cid.oxfordjournals.org/content/early/2013/09/24/cid.cit610.full.pdf+html.
McQuillen DP, Petrak RM, Wasserman RB, Nahass RG, Scull JA, Martinelli LP. The value of infectious diseases specialists: non‐patient care activities. Clin Infect Dis. 2008;47:1051‐1063.
Lahey T, Shah R, Gittzus J, Schwartzman J, Kirkland K. Infectious diseases consultation lowers mortality from Staphylococcus aureus bacteremia. Medicine. 2009;88:263-267.
Robinson JO, ,Pozzi‐Langhi S, Phillips M, Pearson JC, Christiansen KJ, Coombs GW, Murray RJ. Formal infectious diseases consultation is associated with decreased mortality in Staphyloccus aureus bacteraemia. Eur J Clin Microbiol Infect Dis. 2012;31:2421‐2428.
Honda H, Krauss MJ, Jones JC, Olsen MA, Warren DK. The value of infectious diseases consultation in Staphylococcus aureus bacteremia. Am J Med. 2010;123:631‐637.